A. Mansoor1, A. Scholer1, B. D. Patrick1, D. Grech1, Z. C. Sifri1 1New Jersey Medical School,Newark, NJ, USA
Introduction: Pain management after surgery is difficult in low middle income countries (LMICs) due to limited availability of narcotics. The transversus abdominis plane (TAP) block is designed to eliminate somatic incisional pain and is used at times during short-term surgical missions (STSM) to LMICs .We hypothesized that TAP would decrease both early narcotic consumption and postoperative pain during STSM.
Methods: A retrospective chart review was conducted of patients who underwent open cholecystectomy during STSM. All patients were treated with Tylenol 800- 1000 mg PO, Tramadol 50 mg PO, and Toradol 30 mg IV (standard postoperative analgesic regimen). TAP blocks were performed on select patients with 20 ml 0.5% Ropivacaine under ultrasound guidance 30 minutes post op. Data collected included age, gender, ASA, duration of anesthesia and surgery, initial post-op pain score. Outcomes measured included Visual Analog Scale (VAS) pain score at rest (30 mins -2 hrs post-op), intravenous (IV) narcotic doses administered and hospital length of stay (LOS). A comparative analysis was then performed using Student’s T-test (mean ± SD).
Results: 22 patients underwent open cholecystectomy, of those, 11 (50%) received a TAP block. Gender, ASA, and duration of anesthesia were not significantly different among the groups. Age, duration of surgery, and initial pain score were significantly different (Table). Patients who received a TAP block had a 46% decrease in narcotics administered and a 30% shorter LOS when compared to the standard group (Table). No significant difference was noted in the pain scores between the TAP and the standard group (5.2 ± 1.2 vs. 4.7 ± 2.2, respectively, p > 0.5) and no complications from the TAP procedure were reported.
Conclusion: TAP block after open cholecystectomy reduces narcotic usage and shortens LOS during STSMs. TAP block is safe and effective adjunct to standard pain regimen in the early postoperative course in LMIC. Larger prospective studies are needed to confirm these findings.
